Anaplastic gliomas in adults: an update

Purpose of review: The current review summarizes recent advances on the oncogenesis, classification and treatment of adult anaplastic gliomas. Recent findings: According to the 2016 WHO classification, three main molecular subgroups of adult diffuse anaplastic gliomas can be distinguished based on the 1p/19q codeletion and isocitrate dehydrogenase (IDH) mutation status. In the future, this classification may be further refined based on the telomerase reverse transcriptase promoter and alpha thalassemia/mental retardation syndrome X-linked mutation status, gene expression, DNA methylation and genomic profiling. Both newly diagnosed 1p/19q codeleted and 1p/19q-intact anaplastic gliomas benefit from the addition of chemotherapy to radiotherapy. However, in 1p/19q codeleted anaplastic gliomas, Procarbazine, CCNU and Vincristine chemotherapy seems more effective than temozolomide. At recurrence, 1p/19q-intact anaplastic gliomas do not benefit from the addition of bevacizumab to temozolomide. The use of poly(adenosine 5′-diphosphate-ribose) inhibitors may be another way of specifically targeting IDH-mutant gliomas in addition to specific inhibitors, demethylating agents and anti-IDH vaccines. v-raf murine sarcoma viral oncogene homolog B1 (BRAF)-mutant anaplastic xanthoastrocytomas and gangliogliomas may benefit from BRAF and mitogen-activated protein kinase inhibitors. Summary: Molecular characterization is mandatory for integrated diagnosis and appropriate management of adult anaplastic gliomas. Both 1p/19q codeleted and 1p/19q-intact anaplastic diffuse gliomas benefit from early chemotherapy. At recurrence, preliminary data suggest a potential role for targeted therapies in specific molecular subgroups.

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